title: Heart rate and blood pressure interactions in the development of erectile dysfunction in high-risk cardiovascular patients.
abstract: OBJECTIVE
  Erectile dysfunction (ED) is associated with cardiovascular risk factors as elevated systolic blood pressure (SBP), resting high heart rate (HR), and endothelial dysfunction and predicts cardiovascular events. However, the interaction between high HR and SBP and the development of ED remains unclear.
  
  
  RESULTS
  We evaluated 1015 male patients enrolled in the ED substudy of ONTARGET and TRANSCEND, examining the influence of mean HR and mean SBP obtained over all study visits (mean 10.9±1.4 study visits) and their interaction with ED. In patients without pre-existing ED, new onset ED was detected in 29% of patients below, and 41% of patients above, the median of mean HR (OR 1.72, 95% CI 1.8-2.5, p = 0.0047). In patients with pre-existing ED, high HR had no add-on effect. With or without pre-existing ED, high SBP had no influence after adjustment for covariates (OR 1.03, 95% CI 0.66-1.59, p = 0.91). In a continuous model, it was shown that effects of high HR were prominent at low Kölner (Cologne) Evaluation of Erectile Function (KEED) score baseline values and in the presence of SBP above the median.
  
  
  CONCLUSIONS
  In patients at risk for cardiovascular events, high HR is associated with ED, whereas the effect of high SBP was not significant. High resting HR might represent a cardiovascular risk indicator. Whether HR represents a potential treatment target to improve ED in high-risk individuals must be scrutinized in prospective trials.
authors.affiliation: Universitätsklinikum des Saarlandes, Homburg, Germany.
authors.forename: Mario T
authors.initials: MT
authors.lastname: Kratz
authors.forename: Helmut
authors.initials: H
authors.lastname: Schumacher
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Roland
authors.initials: R
authors.lastname: Schmieder
authors.forename: Janine
authors.initials: J
authors.lastname: Pöss
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.forename: Thomas
authors.initials: T
authors.lastname: Unger
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.forename: Teo
authors.initials: T
authors.lastname: Koon
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Mancia
authors.forename: Peter
authors.initials: P
authors.lastname: Sleight
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D007172:Erectile Dysfunction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010410:Penile Erection; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Endothelial dysfunction; endothelial function; heart rate; high cardiovascular risk